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After Discharge

Helpful Points After Discharge
Pain Relief
Simple analgesics e.g. . paracetamol, codalgin.
It is important to take this regularly in order to keep your pain under control.
Keeping your post-operative pain under control allows you to perform your physiotherapy exercises comfortably, so that you get the most out of your new joint replacement.
These medicines are very effective for bone and joint pain when taken regularly. They do not work well if taken intermittently.
Do not take more than what is prescribed.

Anti-inflammatories e.g. Diclofenac, Brufen, Naprosyn etc.
There are useful for moderate pain after soft tissue bone or joint surgery.
A common side effect is indigestion so they must be taken with food and Omeprazole (Losec/Somac) may also be prescribed if you are prone to this.
If side effects such as rash, swelling, diarrhea, or blood appearing in your motions occurs, stop taking the anti-inflammatory and consult your GP.
DO NOT exceed the prescribed dose.

Strong Pain Relief e.g. Tramadol, Oxycontin
These are for severe pain, or pain not controlled with simple analgesics and anti-inflammatories. They are the first medicines to wean off after your surgery.
DO NOT exceed the prescribed dose.

Other Useful pain control methods
Ice packs applied over a towel for 10-15 minutes 3-4 times per day
o Especially after knee replacement
o Help with swelling and joint pain
Physiotherapy exercise program
o Performing your exercise program usually helps reduce the pain (not increase the pain as is commonly believed)

Your Surgical Wound
The Stitches
– Hip and knee replacement patients will have dissolving stitches. These do not need to be removed,
– The wound will be covered with a plastic (opsite) dressing which you peel off 14 days after your surgery.
– Very occasionally fluid may collect under the opsite dressing and threaten to leak out. If this occurs arrange to see your GP practice nurse to have the dressing changed.
Nylon Stitches
– These are used often in the foot or hand. They need to be kept clean and covered. Your discharge summary will detail when and where they need to be removed.

Bruising
It is not uncommon to get some degree of bruising around your wound.
Hip and knee replacement patients may have bruising appear further down the leg 1-2 weeks after the surgery due to effects of gravity.
This bruising can cause tenderness of the leg and or foot. This can be helped by spending 1-2 hours each afternoon elevating your leg on a pillow in bed until the discomfort settles.

Swelling
It is normal to get some swelling further down the leg after hip or knee surgery. This is usually worst 2-3 weeks after your operation, then slowly resolves as your mobility improves.
Swelling can also be minimised by elevating your leg on a pillow in bed for 1-2 hours each afternoon.

Warmth
It is normal to feel increased temperature of the skin around your surgical wound. After hip replacement this may last a week or two.
After knee replacement this is normal for 6-9 months. The increased temperature of the skin is due to inflammation, which is part of the normal healing process.

Fatigue
Tiredness is very common for the first 1-2 weeks after joint replacement surgery and is due to the fact that you have had major surgery.
It is important to ensure you get adequate rest and that you use your pain relief as prescribed to allow you to sleep at night.
Aching at night is very common after knee joint replacement and can last 4-6 weeks. If your relief is not adequate to allow you enough sleep at night then consult with your GP who may elect to add a sleeping tablet temporarily.

Anti-Embolism Stockings
Your anti-embolism stockings will be provided while you are in hospital (unless your skin is too frail to allow their use)
Anti-embolism stockings help to reduce your risk of developing a blood clot (Deep vein thrombosis). You should wear them at night for 6 weeks post op. They can be removed through the day, as walking also reduces your risk of a blood clot (so this is a good time to give them a soak and dry them in the airing cupboard)

Deep Vein Thrombosis (Blood clots)
Patients undergoing hip and knee replacement surgery are at risk of developing a DVT.
You will receive treatments when in hospital to reduce your risks of DVT and medicines will be prescribed for you once you are discharged. These include aspirin (most commonly) and Heparin or Warfarin therapy depending on your history and level of risk.
It is important you take the prescribed medicines.
Symptoms of DVT
– Intense calf pain and/or calf swelling
– Elevated heart rate (uncommon)
– Elevated body temperature (uncommon)
– Intense tenderness of the groin or front/inner thigh.
Should you be concerned that you may have a DVT then see your GP or Emergency Medical Centre as soon as possible.

Pulmonary Embolus (PE)
This is a blood clot that travels from your leg to your lung and is rare.
Symptoms of PE
– sharp catching pain in your chest when you breathe
– sudden onset of shortness of breath
If you develop these symptoms then seek medical attention urgently.

Diet
Once you leave hospital try to resume a healthy balanced diet as soon as possible as this will assist your recovery from your surgery.

Mobility
Follow the instructions on your discharge summary regarding your use of crutches. These are designed to protect your joint and allow proper healing of the muscles around your new joint.
Each day try to increase the distance you walk (weather permitting). There are no set distances as every patient is different. Pace yourself within your energy levels.